The "Childmyths" blog is a spin-off of Jean Mercer's book "Thinking Critically About Child Development: Examining Myths & Misunderstandings"(Sage, 2015; third edition). The blog focuses on parsing mistaken beliefs that can influence people's decisions about childrearing-- for example, beliefs about day care, about punishment, about child psychotherapies, and about adoption.
See also http://thestudyofnonsense.blogspot.com

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Tuesday, March 8, 2016

Flint and Elsewhere: What Aspects of Lead Poisoning Are Irreversible?

Far, far be it from me to imply that lead poisoning in
infants and children is a minor problem, but I feel uneasy about the repeated
declarations that children exposed to lead in the environment suffer “irreversible”
effects. This I find especially worrisome when there is stress on mental
retardation as a possible outcome of lead exposure—to say that mental abilities
have been irreversibly affected when infants and toddlers are lead-exposed may
in some cases be correct, but ignores the many factors that work together to
determine an individual’s mental development. How awful it must be for parents
of lead-exposed children to encounter these statements and know that people
have essentially disposed of their children as beyond help!

The dramatic
statements about lead exposure remind me irresistibly of the “crack baby”
concept of the 1990s, when headlines regularly stated that children who had
been exposed to crack cocaine prenatally were hopelessly ruined. That did not
turn out to be correct, and with proper care given to lead-affected children,
the present claims will probably not be true either. Naturally it would have
been far better if the children had not been exposed to lead to begin with, but
they can be helped to develop at normal levels or close to them. This statement
applies not only to the children of Flint, whose water supply was contaminated,
but also to the many children in the United States who are exposed to lead in
paint, dust, and so on in their own homes.

Where children’s blood lead levels are very high,
the CDC document recommends chelation therapy, a technique that chemically
removes lead from the child’s body. (Please note that while this method is
necessary and effective for management of heavy metals poisoning, it is most
inappropriate and should never be
used for treatment of autism or related problems!) The document points out that
chelation should be used with caution and that primary care providers need to
seek the help of experts. “A child with a [elevated blood lead level] and signs
or symptoms consistent with encephalopathy should be chelated in a center
capable of providing appropriate intensive care services!” (! in original; this
treatment is nothing to take casually—JM). If the treatment is done with oral
chelation agents with the child as an outpatient, the dosage needs to be
carefully monitored, and the treatment needs to be done in a lead-free
environment.

Children with elevated blood lead levels often have
inadequate nutritional intakes of iron, calcium, and vitamins, and nutritional
changes have been recommended as ways to prevent absorption of lead or to combat
its effects. However, it is not at all clear that nutritional factors affect
blood lead levels; it may simply be that children whose families live where
lead exposure is likely also have families who do not have access to healthy
food or information about child nutrition. Nevertheless, improving children’s
early nutrition can be an important step toward good child health and
development, both physical and intellectual. Low levels of protein intake and
lack of iron are associated with problems of brain and mental growth,
especially when they occur in the infant, toddler, and preschool years. Giving
children adequate diets is a way to fight mental retardation, even if it does
not actually lower blood lead levels. The CDC recommends giving pureed meat to infants
as soon as they are developmentally ready, and giving red meat to children once
a day. Dairy products and fruits or fruit juices several times a day are also
recommended. (Minimizing fatty snack foods is also a good idea, in that it will
increase children’s appetites for nutritious foods that may be of less interest
when calorie-rich snacks are available.)
In order for many parents to assure good nutrition to their children, they need
to have not only enrollment in WIC, but access to grocery stores that offer a
variety of foods at reasonable prices.

To ensure that each child reaches the highest
intellectual level he or she is capable of, high quality preschool programs are
of great importance whether or not children have elevated blood lead levels,
and it’s possible that such programs can make the difference between moderate
retardation and fairly normal achievement for some children, if they are
combined with other ways of treating lead exposure. The CDC document also
suggests that developmental monitoring is needed for older children who have
had elevated blood lead levels in early life. These need to continue into
school age, with times of transition like first grade, fourth grade, and
seventh grade getting most attention. Children who are inattentive and
distractible will need help in order to have the maximum benefit from school.

To summarize, we have a number of ways to encourage
good development in children who have been exposed to lead. The lead exposure
may be “irreversible”, but a poor developmental outcome is not inevitable, and
the worrisome trajectory present when no interventions take place can be
reversed to a greater or lesser extent by help we know how to provide. What is
needed, of course, is the political will and the funding to put these
interventions in place. In the case of Flint, if the right decisions are made,
the interventions could begin almost at once, while replacement of water pipes
will take years. Similarly, when lead exposure comes from old paint,
interventions can be of help now, while actually removing lead from houses can
take many years—the process, indeed, can create even more dust and lead
exposure than already exist.

Do I hear any candidates for president talking about
this? Not really…

2 comments:

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About Me https://en.wikipedia.org/wiki/Jean_Mercer

Jean Mercer has a Ph.D in Psychology from Brandeis University, earned when that institution was 20 years old (you do the math). She is Professor Emerita of Psychology at Richard Stockton College, where for many years she taught developmental psychology, research methods, perception, and history of psychology. Since about 2000 her focus has been on potentially dangerous child psychotherapies, and she has published several related books and a number of articles in professional journals.
Her CV can be seen at http://childmyths.blogspot.com/2009/12/curriculum-vitae-jean.mercer-richard.html.